ANS pharm and pathophysiology 6

Question 1

Describe the RAAS system.

Answer 1

Renin production stimulated by decrease in renal blood perfusion
renin acts on angiotensinogen to produce angiotensin 1
ACE found in the lungs produces angiotensin 2
Angiotensin 2 vasoconstricts kidney arterioles via AT1
Angiotensin 2 acts on renal tubules to decrease N1+ and water elimination while increasing K+ excretion
Angiotensin 2 stimulates aldosterone production which amplifies NA+ retention and K+ excretion

Question 2

What enzyme converts angiotensinogen to angiotensin 1?

Answer 2

renin

Question 3

Identify the BEST agents to augment the heart rate in the patient with a heart transplant. (select 2)
a. atropine
b. epinephrine
c. phenylephrine
d. isoproteronol

Answer 3

b. epinephrine
d. isoproteronol

Question 4

The transplanted heart is severed from

Answer 4

autonomic influence

Question 5

In the transplanted heart, the heart rate is determined by the

Answer 5

intrinsic rate of the SA node

Question 6

Patients with a transplanted heart often have resting

Answer 6

tachycardia (HR= 100-120 bpm)

Question 7

There is no _________________- in the transplanted heart.

Answer 7

autonomic input from the cardiac accelerator fibers or the vagus nerve

Question 8

If you want to increase the HR in patient’s with a transplanted heart, you should use

Answer 8

drugs that directly stimulate the SA node (epinephrine, isoproterenol, glucagon)

Question 9

These drugs should not be used in the transplanted heart:

Answer 9

drugs that indirectly stimulate the SA node (atropine, glycopyrrolate, and ephedrine)

Question 10

Because alpha and beta adrenergic receptors are intact on the transplanted heart, the heart will

Answer 10

eventually respond to circulating catecholamines

Question 11

What are paraganliomas?K

Answer 11

neuroendocrine tumors that arise from neural crest cells

Question 12

Paragangliomas tend to grow in

Answer 12

neuroendocrine tissues surrounding the aorta or within the lung, head and neck near the carotid artery
glossopharyngeal nerve
jugular vein
middle ear

Question 13

Multiple system atrophy with autonomic dysfunction results from

Answer 13

degeneration of the locus coeruleus, the intermediolateral column of the spinal cord and peripheral autonomic neurons

Question 14

Multiple system atrophy manifests as

Answer 14

orthostatic hypotension

Question 15

Autonomic dysfunction in patients with multiple system atrophy can prevent physiologic compensation for

Answer 15

vasodilation and tachycardia that can result from the use of volatile anesthetics leading to exaggerated hypotension

Question 16

What effect does verapamil have on the transplanted heart?

Answer 16

AV block

Question 17

What effect does a beta blocker have on the transplanted heart?

Answer 17

increased antagonist effect

Question 18

Is the Bainbridge reflex active in the transplanted heart?

Answer 18

yes (only reflex that is) b/c the SA node stretch will directly increase the SA node’s firing rate

Question 19

What impact do carotid sinus massage and the Valsalva maneuver have on heart rate in the transplanted heart?

Answer 19

no effect

Question 20

The most common cause of cardiac denervation in non-cardiac surgery patients is

Answer 20

diabetes

Question 21

______________ of paragangliomas determines s/sx.

Answer 21

Tumor location

Question 22

Paragangliomas are similar to

Answer 22

pheochromocytomas but they exist in extra-renal locations

Question 23

Paragangliomas rarely secrete vasoactive substances but if they do, they include

Answer 23

norepinephrine
serotonin or kallikrein
histamine or bradykinin

Question 24

The release of norepinephrine cause

Answer 24

hypertension

Question 25

The release of histamine or bradykinin causes

Answer 25

bronchoconstriction and hypotension

Question 26

The release of serotonin or kallikrein can cause

Answer 26

carcinoid-like symptoms such as bronchoconstriction, diarrhea, headache, flushing, and hypertension

Question 27

Small paragangliomas can be treated with

Answer 27

radiation or embolization

Question 28

_____________ can be used to treat carcinoid-like syndrome with paragangliomas

Answer 28

Octreotide

Question 29

Surgical dissection of a paraganglioma that has invaded the internal jugular vein increases the risk of

Answer 29

air embolism

Question 30

Cranial nerve paragangliomas can cause

Answer 30

swallowing impairment
aspiration of gastric contents
airway obstruction

Question 31

Multiple system atrophy involves the degeneration and dysfunction of

Answer 31

diverse central nervous system structures

Question 32

Signs and symptoms of MSA with autonomic dysfunction include

Answer 32

urinary retention
bowel dysfunction
impotence
postural hypotension
impaired pupillary reflex
failure of baroreceptor reflexes

Question 33

Bradycardia that contributes to hypotension in the patient with MSA is best treated with

Answer 33

atropine or glycopyrrolate

Question 34

In the patient with MSA, signs of light anesthesia may be

Answer 34

less apparent in these patients b/c the SNS is less responsive to noxious stimulation

Question 35

Giving ketamine to patients with MSA could potentially

Answer 35

accentuate BP increases

Question 36

Any __________ for the patient with MSA should be continued in the perioperative period

Answer 36

antiparkinsonian medication

Question 37

Autonomic dysfunction in patients with MSA can prevent

Answer 37

physiologic compensation for vasodilation and tachycardia that can result from the use of volatile anesthetics, thus resulting in exaggerated hypotension

Question 38

______________- should be adjusted to lessen the risk of hypotension in the patient with MSA.

Answer 38

IV anesthesia induction drugs

Question 39

Multiple system atrophy with autonomic dysfunction was formerly known as

Answer 39

Shy-Drager syndrome